Research Papers

On the Importance of Modeling Stent Procedure for Predicting Arterial Mechanics

[+] Author and Article Information
Shijia Zhao

Department of Mechanical and Materials Engineering,
University of Nebraska-Lincoln,
Lincoln, NE 68588-0656

Linxia Gu

Department of Mechanical and Materials Engineering,
University of Nebraska-Lincoln,
Lincoln, NE 68588-0656
Nebraska Center for Materials and Nanoscience,
Lincoln, NE 68588-0656
e-mail: lgu2@unl.edu

Stacey R. Froemming

Hybrid Catheterization and Electrophysiology Laboratory,
Children's Hospital and Medical Center,
Omaha, NE 68114-4133

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING Manuscript received July 9, 2012; final manuscript received November 3, 2012; accepted manuscript posted November 28, 2012; published online December 5, 2012. Assoc. Editor: Tim David.

J Biomech Eng 134(12), 121005 (Dec 05, 2012) (6 pages) doi:10.1115/1.4023094 History: Received July 09, 2012; Revised November 03, 2012; Accepted November 28, 2012

The stent-artery interactions have been increasingly studied using the finite element method for better understanding of the biomechanical environment changes on the artery and its implications. However, the deployment of balloon-expandable stents was generally simplified without considering the balloon-stent interactions, the initial crimping process of the stent, its overexpansion routinely used in the clinical practice, or its recoil process. In this work, the stenting procedure was mimicked by incorporating all the above-mentioned simplifications. The impact of various simplifications on the stent-induced arterial stresses was systematically investigated. The plastic strain history of stent and its resulted geometrical variations, as well as arterial mechanics were quantified and compared. Results showed the model without considering the stent crimping process underestimating the minimum stent diameter by 17.2%, and overestimating the maximum radial recoil by 144%. It was also suggested that overexpansion resulted in a larger stent diameter, but a greater radial recoil ratio and larger intimal area with high stress were also obtained along with the increase in degree of overexpansion.

Copyright © 2012 by ASME
Topics: Stress , stents , Modeling
Your Session has timed out. Please sign back in to continue.


Oesterle, S. N., Whitbourn, R., Fitzgerald, P. J., Yeung, A. C., Stertzer, S. H., Dake, M. D., Yock, P. G., and Virmani, R., 1998, “The Stent Decade: 1987 to 1997. Stanford Stent Summit faculty,” Am. Heart J., 136(4), Part 1, pp. 578–599. [CrossRef] [PubMed]
Rogers, C., and Edelman, E. R., 1995, “Endovascular Stent Design Dictates Experimental Restenosis and Thrombosis,” Circulation, 91(12), pp. 2995–3001. [CrossRef] [PubMed]
Gu, L. X., Zhao, S. J., Muttyam, A. K., and Hammel, J. M., 2010, “The Relation Between the Arterial Stress and Restenosis Rate After Coronary Stenting,” J. Med. Devices, 4(3), pp. 0310051-7. [CrossRef]
Timmins, L. H., Miller, M. W., Clubb, F. J., and Moore, J. E., 2011, “Increased Artery Wall Stress Post-Stenting Leads to Greater Intimal Thickening,” Lab. Invest., 91(6), pp. 955–967. [CrossRef] [PubMed]
Migliavacca, F., Petrini, L., Massarotti, P., Schievano, S., Auricchio, F., and Dubini, G., 2004, “Stainless and Shape Memory Alloy Coronary Stents: A Computational Study on the Interaction With the Vascular Wall,” Biomech. Model Mechanobiol., 2(4), pp. 205–217. [CrossRef] [PubMed]
Lally, C., Dolan, F., and Prendergast, P. J., 2005, “Cardiovascular Stent Design and Vessel Stresses: A Finite Element Analysis,” J. Biomech., 38(8), pp. 1574–1581. [CrossRef] [PubMed]
Wu, W., Wang, W. Q., Yang, D. Z., and Qi, M., 2007, “Stent Expansion in Curved Vessel and Their Interactions: A Finite Element Analysis,” J. Biomech., 40(11), pp. 2580–2585. [CrossRef] [PubMed]
Gijsen, F. J., Migliavacca, F., Schievano, S., Socci, L., Petrini, L., Thury, A., Wentzel, J. J., van der Steen, A. F., Serruys, P. W., and Dubini, G., 2008, “Simulation of Stent Deployment in a Realistic Human Coronary Artery,” Biomed. Eng. Online, 7, pp. 23. [CrossRef] [PubMed]
Liang, D. K., Yang, D. Z., Qi, M., and Wang, W. Q., 2005, “Finite Element Analysis of the Implantation of a Balloon-Expandable Stent in a Stenosed Artery,” Int. J. Cardiol., 104(3), pp. 314–318. [CrossRef] [PubMed]
Dombe, D. D., Anitha, T., Giri, P. A., Dombe, S. D., and Ambiye, M. V., 2012, “Clinically Relevant Morphometric Analysis of Left Coronary Artery,” Int. J. Biol. Med. Res., 3(1), pp. 1327–1330.
Fayad, Z. A., Fuster, V., Fallon, J. T., Jayasundera, T., Worthley, S. G., Helft, G., Aguinaldo, J. G., Badimon, J. J., and Sharma, S. K., 2000, “Noninvasive in vivo Human Coronary Artery Lumen and Wall Imaging Using Black-Blood Magnetic Resonance Imaging,” Circulation, 102(5), pp. 506–510. [CrossRef] [PubMed]
Zhao, S. J., Gu, L. X., Hammel, J. M., and Lang, H., 2010, “Mechanical Behavior of Porcine Pulmonary Artery,” in Proceedings of the ASME 2010 International Mechanical Engineering Congress and Exposition; Vancouver, British Columbia, Vol. 2, pp. 771–775.
Pericevic, I., Lally, C., Toner, D., and Kelly, D. J., 2009, “The Influence of Plaque Composition on Underlying Arterial Wall Stress During Stent Expansion: The Case for Lesion-Specific Stents,” Med. Eng. Phys., 31(4), pp. 428–433. [CrossRef] [PubMed]
Auricchio, F., Diloreto, M., and Sacco, E., 2001, “Finite Element Analysis of a Stenotic Artery Revascularization Through Stent Insertion,” Comput. Methods Biomech. Biomed. Eng., 4, pp. 249–263. [CrossRef]
Gastaldi, D., Morlacchi, S., Nichetti, R., Capelli, C., Dubini, G., Petrini, L., and Migliavacca, F., 2010, “Modelling of the Provisional Side-Branch Stenting Approach for the Treatment of Atherosclerotic Coronary Bifurcations: Effects of Stent Positioning,” Biomech. Model Mechanobiol., 9(5), pp. 551–561. [CrossRef] [PubMed]
Avdeev, I., and Shams, M., 2010, “Vascular Stents: Coupling Full 3-D With Reduced-Order Structural Models,” IOP Conf. Ser. Mater. Sci. Eng., 10, p. 012133. [CrossRef]
Dunn, A., Zaveri, T., Keselowsky, B., and Sawyer, W., 2007, “Macroscopic Friction Coefficient Measurements on Living Endothelial Cells,” Tribol. Lett., 27(2), pp. 233–238. [CrossRef]
Carrozza, Jr., J. P., Hosley, S. E., Cohen, D. J., and Baim, D. S., 1999, “in vivo Assessment of Stent Expansion and Recoil in Normal Porcine Coronary Arteries: Differential Outcome by Stent Design,” Circulation, 100(7), pp. 756–760. [CrossRef] [PubMed]
Hsiao, H. M., and Chiu, Y. H., 2012, “Assessment of Mechanical Integrity for Drug-Eluting Renal Stent With Micro-Sized Drug Reservoirs,” Comput. Methods Biomech. Biomed. Eng. [CrossRef]
Lim, D., Cho, S. K., Park, W. P., Kristensson, A., Ko, J. Y., Al-Hassani, S. T., and Kim, H. S., 2008, “Suggestion of Potential Stent Design Parameters to Reduce Restenosis Risk Driven by Foreshortening or Dogboning Due to Non-Uniform Balloon-Stent Expansion,” Ann. Biomed. Eng., 36(7), pp. 1118–1129. [CrossRef]
Mortier, P., De Beule, M., Carlier, S. G., Van Impe, R., Verhegghe, B., and Verdonck, P., 2008, “Numerical Study of the Uniformity of Balloon-Expandable Stent Deployment,” J. Biomech. Eng., 130(2), p. 021018. [CrossRef] [PubMed]
Zahedmanesh, H., John Kelly, D., and Lally, C., 2010, “Simulation of a Balloon Expandable Stent in a Realistic Coronary Artery-Determination of the Optimum Modelling Strategy,” J. Biomech., 43(11), pp. 2126–2132. [CrossRef] [PubMed]
De Beule, M., Mortier, P., Carlier, S. G., Verhegghe, B., Van Impe, R., and Verdonck, P., 2008, “Realistic Finite Element-Based Stent Design: The Impact of Balloon Folding,” J. Biomech., 41(2), pp. 383–389. [CrossRef] [PubMed]
Mortier, P., De Beule, M., Segers, P., Verdonck, P., and Verhegghe, B., 2011, “Virtual Bench Testing of New Generation Coronary Stents,” EuroIntervention, 7(3), pp. 369–376. [CrossRef] [PubMed]
Zahedmanesh, H., and Lally, C., 2009, “Determination of the Influence of Stent Strut Thickness Using the Finite Element Method: Implications for Vascular Injury and In-Stent Restenosis,” Med. Biol. Eng. Comput., 47(4), pp. 385–393. [CrossRef] [PubMed]
Bermejo, J., Botas, J., Garcia, E., Elizaga, J., Osende, J., Soriano, J., Abeytua, M., and Delcan, J. L., 1998, “Mechanisms of Residual Lumen Stenosis After High-Pressure Stent Implantation: A Quantitative Coronary Angiography and Intravascular Ultrasound Study,” Circulation, 98(2), pp. 112–118. [CrossRef] [PubMed]
Hanawa, T., 2009, “Materials for Metallic Stents,” J. Artif. Organs, 12(2), pp. 73–79. [CrossRef] [PubMed]
Scherer, S., Treichel, T., Ritter, N., Triebel, G., Drossel, W. G., and Burgert, O., 2011, “Surgical Stent Planning: Simulation Parameter Study for Models Based on DICOM Standards,” Int. J. Comput. Assist. Radiol. Surg., 6(3), pp. 319–327. [CrossRef] [PubMed]
Rechavia, E., Litvack, F., Macko, G., and Eigler, N. L., 1995, “Influence of Expanded Balloon Diameter on Palmaz-Schatz Stent Recoil,” Cathet. Cardiovasc. Diagn., 36(1), pp. 11–16. [CrossRef] [PubMed]
Dumoulin, C., and Cochelin, B., 2000, “Mechanical Behaviour Modelling of Balloon-Expandable Stents,” J. Biomech., 33(11), pp. 1461–1470. [CrossRef] [PubMed]
Holzapfel, G. A., Stadler, M., and Gasser, T. C., 2005, “Changes in the Mechanical Environment of Stenotic Arteries During Interaction With Stents: Computational Assessment of Parametric Stent Designs,” J. Biomech. Eng., 127(1), pp. 166–180. [CrossRef] [PubMed]
Moller, D., Reimers, W., Pyzalla, A., and Fischer, A., 2001, “Residual Stresses in Coronary Artery Stents,” J. Biomed. Mater. Res., 58(1), pp. 69–74. [CrossRef] [PubMed]


Grahic Jump Location
Fig. 1

The three-dimensional model of the complete stenting system before expansion: nominal state (top), crimped state (middle), and delivery to target lesion (bottom)

Grahic Jump Location
Fig. 2

Mechanical behavior of artery and plaque

Grahic Jump Location
Fig. 3

The equivalent plastic strain (PEEQ) variation during the stenting process

Grahic Jump Location
Fig. 4

The contour plot of the PEEQ of the stent unit at crimping state (left), fully expanded state (middle), and equilibrium state after recoil (right)

Grahic Jump Location
Fig. 5

The contact pressure distribution on the plaque at the fully expanded state of the stent (top) as well as after stent recoil (bottom)

Grahic Jump Location
Fig. 6

The maximum principal stress map on the artery at the fully expanded state of the stent (top) as well as after stent recoil (bottom)

Grahic Jump Location
Fig. 7

The probability distribution of maximum principal stress on the intima

Grahic Jump Location
Fig. 8

The impact of overexpansion on the radial recoil, foreshortening, as well as PEEQ of the stent

Grahic Jump Location
Fig. 9

The impact of overexpansion on the probability distribution of maximum principal stress on intima after recoil



Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In